Diabetes insipidus (a very rare disorder in which sugar is normal but excess water is excreted by the kidney)

Congenital bladder, kidney, or neurological abnormality

A sleep disorder, sometimes related to enlarged tonsils or adenoids

Risk

Factors that increase the chance of bed-wetting include:

Family members with a history of bed-wetting

Significant psychosocial stressors, such as:

Family difficulties

Moving to a new home

Loss of a loved one

A new baby in the home

Initial toilet training that was too stressful

Physical or sexual abuse

Chronic constipation

Attention deficit hyperactivity disorder

Symptoms

The child wakes up and finds the bed wet from urine.

When Should I Call My Doctor?

Most children will have bladder control at night by about 5 years of age. Talk to your doctor if your child is about 5 years old and is still wetting the bed. Your doctor can help determine if the bed-wetting is just a normal part of your child's development or is caused by a condition that may need treatment.

Also call your doctor if you child:

Wets their pants in the daytime

Has pain during urination

Has to go to the bathroom often

Has blood in the urine

Has fever or chills

diagnosis

Diagnosis

The doctor will ask about symptoms and medical history. A physical exam will be done. Your doctor will ask about:

Family history of bed-wetting

Daytime urinary patterns

Problems urinating, such as pain or weak stream

Usual intake of fluids

Type of fluids consumed

Presence of blood in the urine

Strained family dynamics around the issue of bed-wetting

Child's emotional response to the behavior

Recent psychological trauma

If needed your doctor may order tests to look for infections or structural problems:

Urine sample—to check for infections and other problems with the urinary tract

X-rays or ultrasound —if physical abnormalities are suspected

If an underlying problem in the urinary tract is suspected, your child may be referred to a specialist.

treatment

Treatment

Most children will stop bed-wetting by the time they reach puberty. However, bed-wetting can remain a problem for up to 1% of adults.

Most treatment aims to gradually reduce the number of bed-wettings until the child grows out of it. Treatment is rarely appropriate before age six. Bed-wetting does not interfere with social development until after age 6 years.

If your child's bed-wetting is caused by an infection or physical abnormality, your doctor will create a treatment plan for that issue. Since this is uncommon, most children may be treated with one or more of these ways:

Motivation and Family Support

Bed-wetting is rarely an intentional act. Children are usually upset and ashamed when it happens. Do not punish the child. It is very important that parents offer encouragement. The bed-wetting will stop with time. Do not let siblings tease the child who wets the bed.

Keep careful records of the child's progress. Offer consistent support. A very simple motivational method is the use of positive feedback, such as a star chart.

Avoid giving the child anything to drink after 6:00-7:00 in the evening. Have your child void before going to bed. Sugar and caffeine should also be avoided after late afternoon.

Behavioral Conditioning

The doctor may recommend a conditioning device. One example is a pad with buzzer that sounds when wet. The child wears the pad in his underwear. The alarm will wake the child up so they can use the toilet. Parents may need to help the child get to the bathroom and reset the alarm.

Dry bed training is another type of therapy. With this training you follow a schedule where you wake your child up during the night so they can use the bathroom.

Bladder Training

Some doctors suggest bladder-stretching exercises. While awake, the child gradually increases the amount of time between urinations. Do not try this method without talking to the doctor. Holding in urine can lead to day-time wetting and ocassionally urinary tract infections.

Medication

Medicine is rarely given. It may be used for short term situations like a sleepover or vacation. Medication that may be considered include:

Desmopressin (DDAVP)—a hormone that decreases the amount of urine that is made

Imipramine—an antidepressant that lightens the level of sleep and may also decrease how often your child urinates

Prevention

Excess intake of fluid is rarely the cause of bed-wetting. Restricting fluids prior to bed does not help all the time. Still, it is reasonable to have all children empty their bladders prior to bed. Some parents wake their children every few hours to urinate, but most report that they rarely get much cooperation.